She Lost Her Will To Live...and Her Right To Die

She lies in her bed at a Hallandale nursing home, unwilling to speak or move. She is covered with bedsores. She is fed through a tube because she refuses to eat.

Her doctor, her son and the nursing home administrator all say that Wechsler has made it clear that she wants no special treatment -- she wants to be left alone, to die quietly and quickly.

But her dying request is being ignored.

A state regulation, which affects Wechsler and hundreds of other Florida nursing home residents, requires nursing homes to force-feed a patient who refuses to eat, even when family members and doctors ask that the tube be removed, or when the person is terminally ill or in a coma.

The requirement has infuriated advocates for the elderly, left nursing homes in a no-win situation, and created turbulence for state officials who say they are only enforcing the regulations.

And it has caused frustration and anxiety for relatives like Eva Wechsler`s son, a Miramar gynecologist.

``Here`s a woman whose quality of life stinks. She has zero. My mother has turned off from the world,`` Arnold Wechsler said. ``They slipped a tube down her throat and she pulled it out half a dozen times the first day, the next day and the following day. It was ridiculous. It was torturous.``

The feeding is done by placing a naso-gastro tube through the patient`s nose, down her throat and into her stomach, a sometimes painful procedure.

State officials, advocates for the elderly and nursing home administrators are torn over the ethics of the regulation requiring nursing homes to force- feed patients who refuse to eat.

There are no statistics on how many nursing home patients are affected directly by the forced feeding regulation, although officials estimate about 1 percent of the patients statewide -- or 530 -- could meet the criteria.

Most advocates and officials agree that in cases of terminally ill patients or those with a ``living will`` -- a document signed by people who stipulate they don`t want their lives prolonged by machines if they are terminal -- the regulation needs to be changed.

``In a hospital, you are allowed to request that when a person goes into the final phases of death, no heroics are attempted,`` said Joyce Raichelson, coordinator for the Long-Term Care Ombudsman Council, a statewide advocacy group that represents residents of nursing and retirement homes.

``If a nursing home tried that, it would be penalized,`` she said. ``We want those residents to be allowed to be made comfortable in the last hours in their life.``

Advocates say the problem stems from a 1984 ``living will`` statute that excludes artificial feeding as an ``extraordinary measure`` of sustaining life.

Last April, the state Department of Health and Rehabilitative Services interpreted that law as saying nursing homes must continue tube feeding because they are forbidden to withhold nutrition from a resident, regardless of a doctor`s orders.

If the doctor or a family member refuses to allow the patient to be hooked up to a tube, the nursing home must immediately discharge the patient, according to a policy letter written by HRS Licensure Director Amy Jones.

But weeks later, the 2nd District Court of Appeal in Lakeland held that the constitutional right to privacy includes the right of certain patients to have a feeding tube removed.

In that case, Thomas Corbett of Fort Myers sued to remove a tube from his wife, Helen, then 75, who had been in a vegetative state for 2 1/2 years.

Helen Corbett had no living will, but the appeals court decided that people who are comatose have the same right to refuse treatment as those who are terminally ill.

But advocates draw the line with a patient like Wechsler, who has no living will and is not terminally ill or in a coma.

``We`re not condoning euthanasia in any way or form. We do not want to assist people in suicide attempts,`` Raichelson said. ``What we want is to create a dignified atmosphere for someone whose death is impending.``

Not all advocates agree with Raichelson, however.

``When the state applies a living will law to a person who is not terminal, they are overapplying the bounds of the law,`` said Fran Sutcliff, a longtime member of the state ombudsman council. ``People who are not terminal are asserting their constitutional rights by refusing food. If they don`t want to be hooked up to tubes, they shouldn`t have to be.``

In September, Sutcliff served on a statewide task force of health and social service officials that worked out a plan to change the regulations.

Under the proposed revisions, a nursing home would not be required to force- feed a resident who refuses the tube and has a living will or is terminally ill, as long as two doctors and the family agree.

Amy Jones, the HRS licensing director who headed the task force, said the revisions will be presented at a public hearing in Tallahassee next month.